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Belatacept Conversion in Proteinuric Kidney Transplant Recipients: Effects in a Prospective Trial and a Retrospective Cohort

O. Efe1, A. Al Jurdi1, D. Wojciechowski2, K. Safa1, H. Gilligan1, A. Chandraker3, J. Azzi3, A. Weins3, L. V. Riella1

1Center for Transplantation Sciences, Massachusetts General Hospital, Charlestown, MA, 2UT Southwestern Medical Center, Dallas, TX, 3Brigham and Women's Hospital, Boston, MA

Meeting: 2022 American Transplant Congress

Abstract number: 303

Keywords: Glomerular filtration rate (GFR), Graft function, Immunosuppression, Proteinuria

Topic: Clinical Science » Kidney » 46 - Kidney Complications: Non-Immune Mediated Late Graft Failure

Session Information

Session Name: Kidney Complications: Non-Immune Mediated Late Graft Failure

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 5:30pm-7:00pm

 Presentation Time: 6:30pm-6:40pm

Location: Hynes Room 310

*Purpose: Proteinuria after kidney transplantation is associated with worse allograft outcomes. B7-1 expression by podocytes has been linked to proteinuria by inducing podocyte migration which can be targeted by belatacept. We examined the anti-proteinuric effects of calcineurin inhibitor (CNI) to belatacept conversion in proteinuric kidney transplant recipients (KTRs).

*Methods: In a phase I single-arm multicenter prospective trial, we recruited EBV IgG+ adult KTRs >6 months post-kidney transplantation with an eGFR >30 ml/min/1.73m2, proteinuria >1 g/day, and CNI-based immunosuppression. Patients were converted from CNI to belatacept. The primary outcome was 25% reduction in proteinuria at 12 months. In addition, we collected retrospective data from KTRs >3 months post-KT with proteinuria >0.4 g/day who were converted from CNI to belatacept at MGH. For comparison, we also included a retrospective control cohort of CNI patients with 0.4 g/day of proteinuria who remained on CNI.

*Results: In the prospective cohort, 15 KTRs were recruited who had pre-conversion mean eGFR (+SD) of 45.7+13 and median (IQR) proteinuria of 1.8 (1.4-3.5) g/g. At 12 months post-conversion, mean eGFR remained stable at 43.7+13 ml/min/1.73m2 and the primary outcome of 25% reduction in proteinuria was reached in 53% of KTRs with median overall reduction to 1.4 (0.45-2.25) g/g. None of the patients had graft rejection in the first year. One patient had worsening proteinuria and discontinued belatacept. In the retrospective cohort, 9 of 77 belatacept conversion patients had pre-conversion proteinuria >0.4 g/g and available follow-up values. Baseline and post-conversion 12-months median proteinuria were 0.5 (0.47-1.53) g/g and 0.19 (0.12-1.06) g/g, respectively (p=0.496). Mean eGFRs was 49.7+24 at baseline and it remained stable at 54.9+21 ml/min/1.73m2 at 12 months (p=0.24). In the CNI-maintained control cohort (n=21), baseline and 12-month mean proteinuria were 0.52+0.13 and 0.55+0.42 g/g and mean eGFRs dropped from 54+15 to 50+14 ml/min/1.73m2, respectively. Figure 1 summarizes the proteinuria and eGFR values from 3 cohorts.

*Conclusions: Belatacept conversion in proteinuric KTRs leads to stable allograft function and a slight reduction in proteinuria at one year and beyond.

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To cite this abstract in AMA style:

Efe O, Jurdi AAl, Wojciechowski D, Safa K, Gilligan H, Chandraker A, Azzi J, Weins A, Riella LV. Belatacept Conversion in Proteinuric Kidney Transplant Recipients: Effects in a Prospective Trial and a Retrospective Cohort [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/belatacept-conversion-in-proteinuric-kidney-transplant-recipients-effects-in-a-prospective-trial-and-a-retrospective-cohort/. Accessed March 26, 2023.

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